Deformation of the middle zone of the face

The midface consists of the upper jaw, cheekbones, nose and lower orbital rims. It shapes the profile, supports the eyes and determines the bite. A midface deformity is a change in the shape or position of these bones: flattening, sinking or asymmetry. It may be congenital, develop with growth or follow an injury. At UKRMED Maxillofacial Surgery, treatment is planned by surgeon Anna Kravchenko together with an orthodontist.

Where the deformity can be

• Upper jaw — underdevelopment or displacement backwards or sideways, often with a bite problem. The midface looks "sunken" and the lower jaw appears to protrude.
• Cheekbones — sinking or displacement after a fracture.
• Orbit — enlargement after an orbital floor fracture; the eye sinks and double vision occurs.
• Nose — as part of an upper jaw deformity or after injury.

A midface deformity is rarely only cosmetic: it affects chewing, nasal breathing and vision.

Causes

• Post-traumatic deformity — fractures of the cheekbone, upper jaw or orbit that healed in the wrong position or were not reduced in time.
• Congenital conditions — cleft lip and palate, syndromes with an underdeveloped upper jaw.
• Growth disorders — a Class III skeletal bite, where the upper jaw lags behind in growth.

A bony facial deformity after an injury is worth a consultation even years later: modern methods can correct it late.

What is checked at the consultation

• facial asymmetry at rest and during expression;
• bite, mouth opening and chewing;
• eye position, double vision, and sensation in the cheek and lip;
• nasal breathing.

CT is essential — it shows the position of every fragment. A 3D model and virtual plan are built from it. A 2025 systematic review found that virtual planning improves the accuracy of orthognathic surgery compared with traditional planning.

Treatment planning

Midface asymmetry with a bite problem needs a combination of orthodontics and surgery. First the orthodontist aligns the teeth with braces, then the surgeon repositions the jaw, and after surgery the orthodontist finalises the bite.

Operations

• Upper jaw osteotomy (Le Fort I) — the jaw is moved forwards, up or sideways and fixed with plates. More on orthognathic surgery.
• Secondary reconstruction after injury — re-separating malunited cheekbone fragments and fixing them in the correct position, using patient-specific guides and implants based on a 3D plan. Fresh fractures are treated by reduction and fixation.
• Orbital reconstruction — restoring the orbital floor to return the eye to its position.
• Contour correction — with bone grafts or implants, and fat grafting for soft tissue.

Access is mostly through the mouth or in inconspicuous places — below the lashes or in the eyelid crease.

Recovery

Swelling peaks on days two to three and subsides considerably in two to three weeks. For the first weeks: liquid and soft food. Numbness of the upper lip or cheek is common: according to a 2026 systematic review, sensation returns within a year in 92.6% of patients. In the same review, 87.6% of patients were satisfied with the result of orthognathic surgery. The final result is seen after 6–12 months.

When surgery is postponed

• Skeletal growth not complete — jaw surgery for growth disorders is usually done after growth ends so the result does not change with age.
• Untreated decay, gum inflammation or sinus disease — these are treated first, as access is often through the mouth.
• Uncontrolled chronic illness or bleeding disorders.
• Smoking — it impairs bone healing and should be stopped in advance.
• Unrealistic expectations — the surgeon uses the 3D plan to show what can and cannot be changed.

Risks and complications

According to a 2026 systematic review, complications after orthognathic surgery occurred in 32.4% of patients but were mostly minor and self-limiting. The most common are:

• altered sensation of the lip, cheek and upper teeth — it recovers within a year in most patients;
• relapse of the jaw by more than 2 mm — in 18.7% of cases; stability is supported by precise fixation, orthodontics and following the diet;
• swelling, bleeding and infection — in the first weeks;
• nose shape change — moving the upper jaw can widen the base of the nose; the surgeon takes this into account during surgery;
• plate problems — plates are sometimes removed as a separate stage;
• double vision after orbital reconstruction — it can occur temporarily while swelling settles.

Prices at UKRMED

The cost is set after CT and planning — it depends on the extent of surgery.

Sources

1. Ebenezer V., Ganesh P., Vinayagar M. Clinical outcomes, complications and impact on quality of life following orthognathic surgery: a systematic review. Front Oral Health, 2026. https://doi.org/10.3389/froh.2026.1790589
2. Gupta S. Effectiveness of Traditional and Virtual Surgical Planning in Orthognathic Surgery: A Systematic Review and Meta-Analysis. Cureus, 2025. https://doi.org/10.7759/cureus.79033
3. Krasovsky A., Hija A., Zeineh N. et al. Three-dimensional secondary reconstruction of mistreated zygomatic fractures using patient specific surgical guides and implants. Front Oral Health, 2024. https://doi.org/10.3389/froh.2024.1464012